Complex Case Web Form

Presentation for Assisters

February 5, 2021

Agenda

Complex Case Description and Purpose of the Complex Case Web Form

Prepare for Submitting a Complex Case Tips for Submitting a Complex Case What to Expect After Submitting a Complex

Case How to Submit a Complex Case Resources

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Complex Case Description

Complex Case Description: A complex case is a case involving a single consumer or tax household where the

assister has been unable to resolve a specific issue on the consumer or tax household’s application for Marketplace coverage.

Complex cases are not policy questions or general questions about the Marketplace application.

Only federally certified application counselors (CACs) or Navigators in a Federally-facilitated Marketplace (FFM) may submit complex cases.

Purpose of the Complex Case Web Form: This web form allows you to submit a complex case for investigation by the

Complex Case Help Center (CCHC) team.

For policy, programmatic, or general questions, contact us at assisterquestions@cms.hhs.gov.

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Prepare for Submitting a Complex Case

To prepare for submitting a complex case: Attempt to resolve the case at the Marketplace Call Center. Confirm that the consumer’s contact information is up to date on their

application. Collect all necessary information, including:

Phone number you used to call the Marketplace Call Center, date, and summary of discussion;

Submitter’s full name, email address, job title, and phone number; Assister’s ID, organization name and organization type, full name, email

address, job title, and phone number; Consumer’s application ID, state, is the case medically urgent, is there an open

appeal and corresponding appeal information; Complex Case summary, desired results of the Consumer; and Supporting documents (if applicable).

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Tips for Submitting a Complex Case

Tips for submitting a complex case: Completion and submission of the complex case web form MUST be done

in a single session. If you exit the web form at any point prior to submission, all entered data will be lost.

Do NOT include any personally identifiable information (PII) or protected health information (PHI). PII consists of consumer name, address, Social Security number, etc.

If submitting attachments, you MUST redact (black out/white out) any PII or PHI from any documentation submitted (e.g., appeal notice, notice of eligibility determination, letters from the Marketplace, etc.).

Please do NOT submit any medical records or immigration documents. We cannot accept this information and we will delete it.

If your entries exceed the character limit in the text fields, you can include an attachment with the remaining information you were unable to include. 5

What to Expect After Submitting a Complex Case

After you submit a complex case: You will receive a confirmation email containing the

information submitted on the web form and a unique identifier for your case.

The CCHC team will contact the consumer directly to discuss the case.

If the CCHC team cannot contact the consumer, they will contact the assister listed on the complex case.

Either the submitter and/or assister can follow up on the status of your case by emailing assisterquestions@cms.hhs.gov.

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How to Submit a Complex Case

Live Demonstration of the Complex Case Web Form

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Welcome Page

Accuracy of Consumer Contact Information Page

Marketplace Call Center Page

Submitter Contact Information Page

Assister Contact Information Page

Consumer Information Page

Complex Case Details Page

Supporting Documents Page

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Complex Case Summary Page

Confirmation Page

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Resources

To follow up on a complex case, email us at assisterquestions@cms.hhs.gov.

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